First, do not harm.

02Oct

First, do not harm. A saying I’ve heard countless times. Today, I saw firsthand how difficult that can be.

I arrived in Port-au-Prince yesterday, travelling with two Calgary-based plastic surgeons, Christiaan Schrag and Duncan Nickerson. They’ve taken the week off from their busy practices to join Team Broken Earth. They’ve left young families to come down to Haiti. They’ll deal with anything that comes through the door for them over the next five days — burns, tumours, neglected injuries from the earthquake. Mostly, though, they’re coming for one 30-year-old single mother with a disfiguring, debilitating benign tumour that’s bulging out of her jaw. A solid rock mass as big as a large cantaloupe, the tumour has swallowed up everything between her neck and her lower lip. She can’t eat properly, making her noticeably skinny even for Haiti.

Back in May, a Haitian plastic surgeon emailed her photo to Dr. Nickerson to ask his advice. Sadly, there wasn’t anything to be done here in Haiti that could improve the quality of her life.

That could’ve been where the story ended. But the Calgary surgeons couldn’t get this case out of their heads.

For months, they worked with a Haitian surgeon, a surgical prosthesis manufacturer and an engineer to develop a plan. They created models of her jaw based on CT images from Haiti. They laid out an intricate plan for an operation in which they would use parts of the woman’s right fibula to reconstruct her jawbone.

The case was booked for Tuesday, today. Working with the Haitian surgeon, they planned to start at 8 am and work all day. The local staff called a camera crew to cover the story. It was the first time this type of extensive jaw reconstruction using a fibula graft would be done in Haiti.

We discussed this case over and over on the 24-hour trip here — the risks, the benefits, the what ifs, all the possible scenarios.

Almost all. Sometimes, Haiti throws you curveballs. When we arrived yesterday afternoon, the surgeons learned there was a new twist — the woman was HIV positive. She started antiviral medications in July but only intermittently. All this had been missed in the pre-op evaluations.

Even last night, the surgeons believed they might still go ahead with the case. The deciding factor was this morning’s CD4+ count, a blood test that would show the strength of the woman’s immune system and her ability to fight infection. It came back below 200 — woefully short of the cutoff the surgeons had set out.

Perhaps back in Calgary with a fully supported ICU, a specialized team to monitor the patient and a higher CD4+ count, they would have done it. Perhaps. But not in Haiti.

You could see how much it bothered the surgeons — they’d had so much hope to change the life of this woman who washes clothes for a living. But now the surgery is so risky that, ethically, it was a not an option.

“First, do not harm,” said Dr. Nickerson.

The patient took the news stoically, a word I hear over and over to describe people here. Sometimes it seems as they’ve seen so much hardship that they’re immune to new sources of pain. Or perhaps her stoicism is from the tumour itself. Maybe she’s even lost ability to show any emotion on her face.